SOS (Save Our Students) Bully Tip Form
This form is used to submit tips on harassment, intimidation and bullying. Bullying is when a person or group of people repeatedly cause hurt or harm to a person or group of people who feel helpless to respond.
Role of person completing form
Targeted Student's Name (victim)
Your answer
Incident Date
MM
/
DD
/
YYYY
How did you learn about the bullying
Your answer
Did a physical injury result from the incident
Describe any physical injuries if they occurred.
Your answer
Why do you think the harassment, intimidation or bullying occurred?
Your answer
Name of school adult you've already contacted (if any)
Your answer
Name of Bully or Bullies
Your answer
What Happened?
Where did the incident happen?
Witness(es)
Your answer
Name of reporting person (unless wish to remain anonymous)
Your answer
Submit
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